What are the safest statins to take?

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Statins are a class of medications that lower cholesterol through their effect on the liver, the source of most cholesterol in the blood. The drugs inhibit an enzyme the liver uses to synthesize cholesterol, which prevents it from forming. Statins also help the liver remove cholesterol already circulating in the blood.

Low-density lipoproteins (LDL) are the type of cholesterol that statins most effectively reduce. Statins also help decrease blood fat, known as triglycerides, and raise high-density lipoproteins (HDL).

LDL is the harmful type of cholesterol that can lead to heart attacks and strokes, while HDL is the healthful type, as it helps remove cholesterol from the body.

Statins available to people in the United States include:

• atorvastatin (Lipitor)
• pravastatin (Pravachol)
• lovastatin (Mevacor, Altoprev)
• fluvastatin (Lescol)
• simvastatin (Zocor)
• rosuvastatin calcium (Crestor)

Learn more about statins.

Medical News Today sought the expertise of Cheng-Han Chen, MD, board certified interventional cardiologist and medical director of the Structural Heart Program at Memorial Care Saddleback Medical Center in Laguna Hills, CA.

The Food and Drug Administration (FDA) has approved all statins, and they are safe for most people, according to Chen. That said, no one statin is the safest option for everyone because several factors can cause this to vary among individuals.

“There are certain differences between statins — such as drug absorption, metabolism, and excretion — that can influence the side effects,” he says. “If someone has a side effect with a particular statin, doctors will usually switch to a different statin and frequently find that the side effects either improve substantially or resolve completely.”

Chen adds that other factors influencing safety include drug interactions and co-occurring conditions.

These include the following:

Myopathy

A 2017 review reports that statins can cause myopathies — conditions affecting the muscles — through a direct effect on muscle tissue. They may also cause myopathies through an autoimmune effect, which means they trigger a body’s attack against itself.

Evidence indicates that direct myopathies — ranging from muscle pain to severe destruction of muscle cells — affect 10–20 cases per 10,000 people who take statins per year. About 2–3 cases per 100,000 individuals develop autoimmune myopathies, which may manifest as muscle weakness or muscle cell death.

Learn more about statins and muscle pain.

Diabetes

Evidence suggests that the risk of developing diabetes from statins is 10–20 cases per 10,000 people. The likelihood rises with the statin dose, and it happens mainly in those who already have risk factors for diabetes. Examples of risk factors include a high body mass index or blood tests that indicate impaired blood sugar control.

Learn more about risk factors for diabetes.

Hemorrhagic stroke

This is the type of stroke that happens when a blood vessel in the brain ruptures and bleeds.

Findings estimate that approximately 5–10 cases per 10,000 individuals who have taken statins for five years can experience a hemorrhagic stroke. The risk is higher in those with cerebrovascular disease, or conditions that impair blood flow to the brain.

Learn more about hemorrhagic stroke.

Other side effects

Statin use has some associations with other possible side effects, which may include:

• a small risk of liver injury
• impairments in thinking and memory
• a small risk of cancer

More research is necessary to provide proof of these effects.

All statins undergo metabolism — or chemical changes — in the liver, but simvastatin and lovastatin undergo them more extensively. This extensive metabolism makes them more susceptible to certain drug interactions that can increase the concentrations of the medications. Consequently, this raises the risk of side effects.

Medications that cause such interactions include:

• macrolide antibiotics, such as azithromycin (Zithromax)
• antifungal azoles or drugs that inhibit the growth of a wide range of fungal infections, such as fluconazole (Diflucan)
• cyclosporine (Gengraf, Neoral, Sandimmune), a drug that suppresses the immune system

Just as no statin is safest for all individuals, no one statin is the best choice for everyone. Regarding side effects, the option to pick is the one that a person can tolerate the best.

Aside from side effects, Chen discusses some special considerations that affect a statin choice.

“In people with established cardiovascular disease or many risk factors for cardiovascular disease — conditions that affect the heart and blood vessels — doctors typically recommend a ‘high intensity’ statin,” he says. “These include atorvastatin or rosuvastatin, as research indicates they have the most cardiovascular benefit.”

Chen explains that sometimes doctors do not recommend any statins at all. This pertains to individuals who take the aforementioned medications that cause drug interactions. “Also, doctors advise against statins if someone has active liver disease,” he says. “In chronic liver disease, they recommend dose adjustments for particular statins — rosuvastatin or pravastatin.”

Statins are drugs that doctors prescribe to lower LDL cholesterol. The safest statin for a person will depend on how well they tolerate the side effects, as well as their co-occurring conditions. Additionally, other medications they take are important, as macrolide antibiotics, antifungal drugs, and cyclosporine can interact with statins in a way that increases the risk of side effects.

Other safety concerns include a higher risk of myopathy, diabetes, and hemorrhagic stroke.

Doctors do not recommend any statins for people who have active liver disease or take medications that interact with them. A person should talk with a doctor if they have concerns regarding which statin to take for their circumstances.